Hypopituitarism in the elderly

Antonopoulou, Marianna; Sharma, Rajeev; Farag, Amal; Banerji, Mary Ann; Karam, Jocelyne

doi:10.1016/j.maturitas.2012.05.002

Cited by 20 publications

(19 citation statements)

References 99 publications

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“…Multifactorial analysis also showed that preoperative hypopituitarism was significantly associated with age in the present study. The association between age and hypopituitarism has also been noted in previous studies [ 5 , 25 ]. In patients with NFPAs, patient age was associated with postoperative functional recovery [ 26 ].…”

Section: Discussionsupporting

confidence: 81%

“…Clinically “silent” NFPA may result in supra-normal serum hormone concentrations of the specific adenoma cell type but without the usual clinical manifestations expected with excessive levels of that hormone [ 4 ]. Partial or complete hypopituitarism may occur in NFPA patients when 95% of pituitary cells are damaged [ 2 , 5 ]. In contrast, functional pituitary adenomas (i.e., growth hormone [GH], adrenocorticotropic hormone [ACTH], thyroid stimulating hormone [TSH], and prolactin [PRL] adenomas or prolactinomas) secrete sufficient hormones to cause corresponding signs and symptoms of hyperprolactinemia, acromegaly, or Cushing’s syndrome.…”

Section: Introductionmentioning

confidence: 99%

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A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

Wang

Ding

et al. 2017

Oncotarget

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The purpose of this study was to investigate the differences between pre- and postoperative pituitary hormone levels in patients undergoing surgical resection of pituitary adenoma and to identify factors associated with preoperative hypopituitarism.Data from 81 patients with histologically confirmed functioning and non-functioning pituitary adenomas (NFPA) who underwent transsphenoidal resection from January 2011 to December 2013 were retrospectively analyzed. Logistic regression was applied to analyze factors associated with preoperative hypopituitarism. In patients with functioning pituitary adenomas, GH and PRL levels declined after the operation; TSH, FSH and LH levels returned to preoperative values after an initial decline at postoperative day 1. In contrast, with the exception of a postoperative reduction in PRL level, NFPA patients had postoperative ACTH, TSH, FSH and LH levels at 4 months follow-up that were similar to preoperative levels. Similarly, a decrease in total hormone index was observed following surgery irrespective of NFPA type and in null-cell type NFPA patients with values increasing over the 4-month follow-up period. A higher percentage of patients receiving partial resection had high PRL levels (≥200 ng/ mL) compared to those receiving complete resection. Age (P = 0.041) and male sex (P = 0.004) were significantly associated with preoperative hypopituitarism. In conclusion, the postoperative total hormone index decreased immediately following surgery in all patients with pituitary adenoma who underwent resection, and then increased over the follow-up period. The extent of surgical resection correlated with PRL levels >200 ng/mL. Age and male sex were also independent risk factors for preoperative hypopituitarism.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

Wang

Ding

et al. 2017

Oncotarget

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“…They were undergoing a chronic hormone-replacement therapy within two years as the treatment for primary infertility or polycystic ovary syndrome or were undergoing a supportive hormonal therapy for the treatment of prolactinoma. There are also studies that support the occurrence of IIH in the mentioned states (22,23). The IIH in these conditions might appear due to the stimulatory effect of estrogen on CSF production (24, 25), which might be especially potentiated in obese patients (25).…”

Section: Discussionmentioning

confidence: 96%

Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series

Ljubisavljević¹,

Trajković²

2016

Acta Facultatis Medicae Naissensis

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According to the definition, idiopathic intracranial hypertension (IIH) is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it.We present an overview of possible etiopathogenetic mechanisms, clinical presentations and therapeutic interventions from a series of patients hospitalized with the clinical picture and final diagnosis of idiopathic intracranial hypertension (IIH). All data were collected from the moment of IIH diagnosis as well as three months later.The obtained data showed that IIH is a disease that primarily affects obese women in early and midlife. The positive correlation between values of cerebrospinal fluid pressure and body mass index was observed. The disorders of sexual hormones were identified as a possible etiology for IIH female patients. Headache, papilloedema, decreased visual acuity, vertigo and cranial nerve palsy were identified as the most prevalent IIH clinical presentations. The existence of stenosis and hypoplasia of the sigmoid and transverse sinus were confirmed only in one third of IIH patients. Pharmacotherapy combined with weight loss was efficacious in a large number of patients. In this series, there were no short-term consequences of IIH.The results suggest the importance of early and accurate looking for IIH in obese early and midlife women with any hormonal imbalances having a variety of neurological expression, mostly presented as headaches and visual disturbances. Early detection of IIH might influence the timely treatment and prevent far-reaching and severe clinical consequences. Key words: idiopathic intracranial hypertension, headache, pathophysiology O r i g i n a l a r t i c l e I NT ROD U CT I ONAccording to the definition, idiopathic intracranial hypertension (IIH) is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it (1, 2).It is widely accepted that IIH usually affects patients who are between 20 and 40 years of age and is combined with obesity. Nevertheless, there are cases when IIH occurs even earlier, although it is not then generally accompanied by obesity (3). Women are more affected than men, 4 to even 15 times, as has been estimated (4). The frequency of IIH occurrence is 1-2 per 100.000 of the general population, and it is highest in the population of obese women (5). The estimations show that the total IIH widespread presence corresponds to the rate of obesity in an area (1). Regarding the existence of IIH, clinical phenotypes with poor clinical presentation, when there are no diagnostic considerations of the disorder, the real incidence and prevalence rates are estimated to be higher than mentioned (6).The possible etiological parameters of this disorder suggest that the basis for ...

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“…Like pseudogout, one of the diseases, which can be seen in old age, is hypopituitarism. Particularly, when hypopi-tuitarism occurs with nonspecific signs such as fatigue, decrease in appetite, nausea and weight loss, which are normally seen in old age, it may cause misdiagnosis and/ or delay in diagnosis (4). Additionally, with the diseases like polymyalgia rheumatica and rheumatoid arthritis (RA), which become more common in this age group, the differential diagnosis between these diseases and pseudogout becomes difficult.…”

Section: Introductionmentioning

confidence: 99%

Miscible Two Diseases in Old Age: Hypopituitarism and Pseudogout

et al. 2016

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Calcium pyrophosphate dihydrate deposition disease is a disease characterized by collecting of crystals in hyaline cartilage, fibrocartilage and soft tissues, related to many endocrine and metabolic conditions, and seen more commonly in old age. Hypopituitarism may occur in old age with fatigue, decrease in libido, weight loss and musculoskeletal symptoms as a major cause of the overall condition impairment. As one gets older, the signs of these two diseases may progress even without any significant disease. The natural process which comes with old age, and pseudogout and hypopituitarism can mask one to another clinically and the symptoms of three situation may be overlapping. This can lead to difficulty and delay in diagnosis. Our case was an elderly female patient diagnosed with hypopituitarism and pseudogout.

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Hypopituitarism in the elderly

Cited by 20 publications

References 99 publications

A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series

Miscible Two Diseases in Old Age: Hypopituitarism and Pseudogout

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